Psychological care is just as important as washing your hands

It had started. For a good two weeks after the first case of Covid-19 arrived in Ireland, the counselling service was still operating as normal – only with a very intense cleaning routine as the new addition. But on the 12th of March we got a phone call from one of the residential services to let us know that the service was now closed to external visitors – including counsellors. It was the first of many calls, and ten days later we also halted face-to-face counselling sessions in our two standalone counselling centres in Phibsborough and Inchicore.  

It was a difficult and heart breaking decision. The Dublin Simon Counselling Service has been operating since 2012, and offered just under 4,000 counselling hours in 2019, in addition to informal counselling drop–in clinics, emotional wellbeing groups and a 7-day a week suicide prevention service. We were worried about the impact a disruption to our service provision would have on our clients, in particular at these challenging times. So for another week, the core counselling team were busy putting measures in place to shift all existing counselling to phone or video calls. That said, counselling is about providing a safe space to talk, about connectedness, so we were a little worried about how our clients would take the switch from face-to-face counselling to linking in on the phones.   

Social distancing measures to combat the spread of Coronavirus are challenging for most of us, but even more so for clients affected by homelessness: The fear of loneliness is a huge factor with homeless clients in general, even more so during this pandemic. They already feel invisible at the best of times, empty streets, closed shops, restaurants and coffee shops, keeping a distance of at least 2 metres to others (others that potentially wear a mask!), not being able to go out and meet their family or friends, all this can turn into an even more increased sense of isolation and therefore have an impact on their mental health. This in particular because it is an imposed isolation rather than a choice, an entirely unfamiliar situation for all of us that we still have to figure out how to make sense of.  

 Humans are social beings, and those experiencing homelessness are no different. One of the main goals of counselling is to give our clients a sense of being seen, of being important, of being listened to. We are helping them learn new, healthy ways of relating to others. Imposed social isolation can send them off into a downwards spiral, leading to depression, increased substance or alcohol use, or even self-harming or suicidal behaviours. Loneliness can make them ill.  

 As unfamiliar and scary this new situation is for all of us, we are all doing our best to adapt and cope with it. Counselling sessions and emotional support are now taking place remotely, and our clients were amazingly fast in making the switch to the phone! Most of our existing clients are by now continuing their weekly sessions on the phone, WhatsApp or through Zoom. Some have opted out of phone sessions but do remain in contact with their counsellors through text messages. Some have asked their counsellors for two shorter phone sessions per week rather than the traditional once a week. We can trust them to communicate their needs around staying in contact.  

While groups are not taking place anymore right now, we have teamed up with the Client Engagement Team and are supplying mental health activities and tips in the daily activity packs they send out to our residential services. We have implemented an emotional phone support that clients from all homeless service providers in the Dublin Area can ring using a Freephone number. It is hugely important right now that clients have a space to recognise and voice their feelings and thoughts, and that they learn to be compassionate towards themselves and others, so they can support each other while acknowledging their difficulties. It’s important for all of us, clients and staff alike, to realise that we are all doing the best we can in this unprecedented situation. 

 What’s really important while we are in isolation is to maintain a daily routine. At these times of uncertainty we need things that are familiar and structured to feel safe. This makes us feel less powerless and gives us a sense of control. For our clients, a lot of their daily routines went out the window as soon as the restrictions came in place. Addiction day programmes, counselling and key working were paused. Educational classes were suspended. Planned admissions to addiction treatment facilities were put on hold for the duration of the crisis. This break in routine that we are all experiencing on one level or another is much more impactful with a client group whose emotional resources and coping skills aren’t that well developed to begin with. That break in routine, the not having anywhere to go during the day for distraction, it can be very difficult to manage. They might ask themselves what is the point in going on trying. Some are consumed with fear of having picked up the virus while they are waiting for a test or test result, and then others are trying to cope with the loss of “normal” day to day things like birthdays or Sunday visits to their mothers.  

 That said, as an organisation, and the homeless sector in itself, we seem to have used the crisis as an opportunity. Many addiction support groups have switched to Zoom. Counselling and key working have switched to the phones. Instead of going to classes and groups, activity packs are sent to services and distributed by staff, or staff are organising impromptu coffee mornings or exercise sessions using YouTube. Of course this flexibility to react doesn’t come without its challenges – privacy for 1-to-1 phone calls remains an issue in hostels or family hubs, and many clients do not have access to WiFi or their own mobile phones, but these things are being looked into. It’s a work in progress, and we always need a plan B (or C) up our sleeves. 

 So the situation as is is certainly not ideal, but it is necessary to protect our client group, many of whom have underlying health issues, are immunocompromised or have HIV. Communicating with them through phone or video calls is necessary to protect them from infection with the virus and it enables them to look after their mental health just as much as frequent hand washing does for their physical health. We cannot predict the long-term consequences of the recent measures put in place on this already very vulnerable group of people. What we do know though is that while we cannot meet all the needs they have at the moment, everyone is trying their best to get their most basic needs met. And despite of the vulnerability that characterises our client group, they are also among the most resilient people you will ever meet. They will adapt, plough through, and come out on the other end of this crisis and continue.  

*The counselling service is still open for new referrals into both the suicide prevention and the general counselling service. The Freephone number for clients from all homeless service providers who are emotionally struggling with the emotional impact of the Covid-19 crisis is operating from 8am-10pm on weekdays and 4pm-10pm on weekends (1 800 844 600).